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Reference values of diaphragmatic dimensions in healthy children aged 0–8 years

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Abstract

Diaphragmatic thickness (Tdi) and diaphragm thickening fraction (dTF) are widely used parameters in ultrasound studies of the diaphragm in mechanically ventilated children, but normal values for healthy children are scarce. We determined reference values of Tdi and dTF using ultrasound in healthy children aged 0–8 years old and assessed their reproducibility. In a prospective, observational cohort, Tdi and dTF were measured on ultrasound images across four age groups comprising at least 30 children per group: group 1 (0–6 months), group 2 (7 months-1 year), group 3 (2–4 years) and group 4 (5–8 years). Ultrasound images of 137 healthy children were included. Mean Tdi at inspiration was 2.07 (SD 0.40), 2.09 (SD 0.40), 1.69 (SD 0.30) and 1.72 (SD 0.30) mm for groups 1, 2, 3 and 4, respectively. Mean Tdi at expiration was 1.64 (SD 0.30), 1.67 (SD 0.30), 1.38 (SD 0.20) and 1.42 (SD 0.20) mm for groups 1, 2, 3 and 4, respectively. Mean Tdi at inspiration and mean Tdi at expiration for groups 1 and 2 were significantly greater than those for groups 3 and 4 (both p < 0.001). Mean dTF was 25.4% (SD 10.4), 25.2% (SD 8.3), 22.8% (SD 10.9) and 21.3% (SD 7.1) for group 1, 2, 3 and 4, respectively. The intraclass correlation coefficients (ICC) representing the level of inter-rater reliability between two examiners performing the ultrasounds was 0.996 (95% CI 0.982–0.999). ICC of the inter-rater reliability between the raters in 11 paired assessments was 0.989 (95% CI 0.973–0.995).

   Conclusion: Ultrasound measurements of Tdi and dTF were highly reproducible in healthy children aged 0–8 years.

   Trial registration: ClinicalTrials.gov identifier (NCT number): NCT04589910.

What is Known:

• Diaphragmatic thickness and diaphragm thickening fraction are widely used parameters in ultrasound studies of the diaphragm in mechanically ventilated children, but normal values for healthy children to compare these with are scarce.

What is New:

• We determined normal values of diaphragmatic thickness and diaphragm thickening fraction using ultrasound in 137 healthy children aged 0–8 years old. The diaphragmatic thickness of infants up to 1 year old was significantly greater than that of children from 2 to 8 years old. Diaphragmatic thickness decreased with an increase in body surface area. These normal values in healthy children can be used to assess changes in respiratory muscle thickness in mechanically ventilated children.

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Data Availability

All relevant data is contained within the article: The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

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Acknowledgements

The authors thank Ko Hagoort for text reviewing.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery and Intensive Care, Erasmus , Sophia Children’s Hospital, MC, Rotterdam, the Netherlands

    Anita Duyndam, Joke Smit, Monique van Dijk, Dick Tibboel & Erwin Ista

  2. Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

    Leo Heunks, Jeroen Molinger & Dick Tibboel

  3. Division of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA

    Jeroen Molinger

  4. Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands

    Marloes IJland

  5. Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

    Joost van Rosmalen

  6. Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

    Joost van Rosmalen

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  1. Anita Duyndam
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Contributions

Anita Duyndam: Conceptualisation, methodology, investigation, writing—original draft, project administration, formal analysis, data curation, visualization, software, validation. Joke Smit: Methodology, investigation and review and editing. Leo Heunks: Review and editing. Jeroen Molinger: Conceptualisation, methodology, review and editing. Marloes IJland: Review and editing. Joost van Rosmalen: Methodology, formal analysis, review and editing. Dick Tibboel: Conceptualization, resources, review and editing. Monique van Dijk: Conceptualization, review and editing. Erwin Ista: Conceptualisation, methodology, validation, review and editing, supervision.

Corresponding author

Correspondence to Anita Duyndam.

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Ethical approval

The Medical Ethics Review board at Erasmus MC Rotterdam approved the study (METC No. NL70476.078.19). The study was performed in accordance with the ethical standards of the Declaration of Helsinki.

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Written informed consent was obtained from the parents.

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The authors declare no competing interests.

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Communicated by Peter de Winter.

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Duyndam, A., Smit, J., Heunks, L. et al. Reference values of diaphragmatic dimensions in healthy children aged 0–8 years. Eur J Pediatr 182, 2577–2589 (2023). https://doi.org/10.1007/s00431-023-04920-6

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